Frequently Underappreciated Considerations in Anti-arrhythmic Drug Therapy

Anti-arrhythmic drugs (AADs) have been a mainstay of dysrhythmia control for over a century. Even in the current era of evolving ablation use and technology, AADs remain therapeutically important. Nonetheless, the effectiveness of AADs may be incomplete and/or adverse effects may limit their use despite efficacy. Ideally, to maximize the clinical profile of AADs, clinicians should be aware of the full array of their complexities and selection options. However, commonly, some of them seem to be frequently underappreciated. Among others, these include dosing intricacies, targeting therapy to the arrhythmia trigger, avoiding habitual choices of AAD selection, consideration of AAD combinations, and more. These factors are discussed in this paper as a means of improving AAD use by clinicians and tolerance by patients. Notably, it is only these issues that are the focus of this paper, which is not meant as a review of the pharmacologic profile of each of our AADs.